Dug the Dog strikes again, as he did three weeks ago. I had a couple of ideas for a post this week, but none of them were time-sensitive or timely. Then, over the weekend, I saw a post on the antivaccine crank blog Age of Autism by Dan “Where are the Autistic Amish” Olmsted entitled Weekly Wrap: Another Medical Practice with a Sane Vaccine Schedule – and No Autism. Given the tendency towards a—shall we say?—lack of accuracy of Olmsted’s previous reporting, it’s no surprise that he’d latch on to this study. I’m also seeing it appear around other antivaccine websites. I had gotten wind of it late last week, a few of my readers having sent it to me but hadn’t decided yet whether to blog about it. Then it appeared on AoA. Thanks, Dan.
So let’s see how this study is being spun by the antivaccine movement:
When we at Age of Autism talk about ending the epidemic, the “to do” list seems almost overwhelming – funding a vax-unvaxed study, getting mercury out of flu shots, proving the HepB shot is nuts, wresting control of the agenda from pharma, fixing Vaccine Court (this time in the good sense of “fix”), establishing that biomedical treatments help kids recover, and on and on.
But there’s a shortcut to all this, and it goes straight through pediatricians’ offices. The evidence is growing that where a sane alternative to the CDC’s bloated vaccine schedule is offered, and other reasonable changes adopted, autism is either non-existent or so infrequent that it doesn’t constitute an epidemic at all.
The latest example comes from Lynchburg, Va., and the pediatric practice of Dr. Elizabeth Mumper. She noticed a frightening rise in autism in the 1990s. Concerned that vaccines and other medical interventions might be playing a role – concerned in other words that SHE was playing a role — Mumper changed course.
Fewer vaccines. Fewer antibiotics. No Tylenol. Breast-feeding. Probiotics. Good, pesticide free diets.
Since then, hundreds more children have been seen in her practice, Advocates For Children. But no more autism.
I did not coordinate my topic for today with Harriet’s excellent review yesterday of Satel and Lilienfeld’s excellent book; the timing is just fortuitous. Harriet discussed popular abuses of neuroscience, which often amount to an oversimplification and hyperreductionism of a complex area of study. I was recently asked to comment on a claim that I feel falls squarely into this realm – so-called conscious discipline.
From the conscious discipline website:
It surpasses behavioral approaches that teach specific behaviors, and offers a neurodevelopmental model of the brain…
The Conscious Discipline Brain State Model becomes a frame for us to understand the internal brain-body states that are most likely to produce certain behaviors in children and in ourselves. With this awareness, we learn to consciously manage our own thoughts and emotions so we can help children learn to do the same.
They even offer a helpful picture of the brain to illustrate their model (above).
Sally Satel and Scott Lilienfeld have written a new book, Brainwashed: The Seductive Appeal of Mindless Neuroscience. Its purpose is not to critique neuroscience, but to expose and protest its mindless oversimplification, interpretive license, and premature application in the legal, commercial, clinical, and philosophical domains.
The brain is a wondrous thing: “…the three pound universe between our ears has more connections than there are stars in the Milky Way.” Trying to understand how it works and how it generates conscious awareness and subjective feelings is a daunting task. Neuroimaging is one of the tools we are using to study it. Unfortunately, people get so enthusiastic about its possibilities that they are constantly tempted to read more into the images than is really there. This has given rise to a new phrenology that interprets our mental characteristics with pretty colored pictures. We are easily impressed by pictures; after all, a picture is worth a thousand words.
Brain imaging can’t show us what is going on in the mind of the person. It shows areas that have increased oxygen consumption. A spot lights up when a person thinks or acts, but that doesn’t tell us much. Single blobs that light up in the brain have been interpreted as centers for things like love, rewards, hate, and belief in God. This is sometimes referred to as “blobology.” They found an area in one person that lit up when he thought about an actress he loved. That area was thought to be a “reward” center. But it also lit up when he thought of Ahmadinejad! So they did some fancy footwork and rationalized that he believed that the Jewish people would endure and therefore he derived pleasure from the idea that Ahmadinejad would fail. That’s pretty far-fetched. Occam’s razor would suggest that maybe the area that lit up was reacting not to pleasure, but to something else. People tend to read what they want to see into ambiguous patterns like a Rorschach test. Mental functions are rarely limited to a single spot in the brain; multiple areas are involved and interconnected. Researchers are increasingly moving away from blobology and towards pattern analysis where they look at the patterns of activation across the entire brain. (more…)
A recently published epidemiological study in JAMA Pediatrics looked at the association between induction and enhancement of labor and the risk of autism. The researchers found a positive association, especially with males. The study has been variously reported in the popular press with causal interpretations not justified by the data.
The study itself is very robust – the authors looked at 625,042 live births, including 5,500 children with a diagnosis of autism. They found:
Compared with children born to mothers who received neither labor induction nor augmentation, children born to mothers who were induced and augmented, induced only, or augmented only experienced increased odds of autism after controlling for potential confounders related to socioeconomic status, maternal health, pregnancy-related events and conditions, and birth year. The observed associations between labor induction/augmentation were particularly pronounced in male children.
Although this is a large study, it is one study, and so the correlation needs to be independently confirmed. But if we assume the correlation is accurate, the next question is – what is the arrow of causation? Observational studies can only indicate an association. By themselves they cannot prove causation, although multiple observational studies may be able to triangulate to the most likely causal interpretation. (more…)
Mercury in unequivocally a neurotoxin. It is especially damaging to the developing brain. But it’s the dose that makes the toxin, and so a low enough exposure even to something known to be potentially harmful may not be. Further, the body has mechanisms for dealing with toxins, and toxins in the body may not be reaching the cells they can potentially damage in significant amounts. Therefore if we want to know if a potential toxin is actually causing any harm to people we need to do some type of epidemiological study – correlating exposure to possible adverse outcomes. All the studies in petri dishes and with cell cultures just won’t answer the question of harm.
The question of whether or not mercury in vaccines has caused neurological harm, specifically autism, has been largely answered. Numerous studies have shown no association between the amount of mercury exposure from vaccines and the risk of developing autism. A separate mercury-related question, however, is whether or not there is any risk of harm from mercury exposure from seafood. Mercury is methylated by bacteria into methymercury, and through them gets into the food chain in the oceans. Fish that eat other fish then concentrate the mercury in their tissues, and so predatory fish and sea mammals tend to have high concentrations of methymercury.
This has led to some precautionary recommendations, including that pregnant women should not eat tuna or other fish with high mercury levels. This makes sense, but what is the actual risk? The precautionary principle can also cut both ways. Fish contain many high-quality nutrients important for a developing brain, such as polyunsaturated fatty acids. Removing this food source from the diet of pregnant women may have unintended negative consequences.
In the last decade or so there has been increasing research into non-invasive brain stimulation techniques for a variety of conditions. These include transcranial direct current stimulation (tDCS), transcranial alternating current stimulation (tACS), random noise stimulation (tRNS), and transcranial magnetic stimulation (TMS). These techniques alter the excitability of neurons in the brain, seem to have an effect on plasticity (the ability to form new connections), and can modulate the activity of brain networks.
Overall the current research is preliminary but encouraging. Many of the details of exactly how to apply this new technology, however, are still being worked out. One recent review summarizes this complexity:
tDCS can be used to manipulate brain excitability via membrane polarisation: cathodal stimulation hyperpolarises, while anodal stimulation depolarises the resting membrane potential, whereby the induced after-effects depend on polarity, duration and intensity of the stimulation. A variety of other parameters influence tDCS effects; co-application of neuropharmacologically active drugs may most impressively prolong or even reverse stimulation effects. Transcranial alternating stimulation (tACS) and random noise stimulation (tRNS) are used to interfere with ongoing neuronal oscillations and also finally produce neuroplastic effects if applied with appropriate parameters.
Finding a simple fix for complex problems is highly appealing, which drives a persistent market in simple fixes, whether or not they are actually effective. The growing “brain training” industry is an example of this – the concept being that performing simple tasks, such as playing particular games, can have wide-ranging cognitive benefits. Unfortunately the evidence has not been kind to this notion.
Related to the brain training concept is auditory integration training. One permutation of this, the Tomatis Method, describes it this way:
The sound message is correctly heard but poorly analyzed in an emotional framework. The brain protects itself by constructing barriers that can result in the development of various disorders.
You can do the listening sessions repeatedly by using specially designed devices that stimulate the brain and progressively help it more effectively analyze the sensory message.
Your ear is not used only for hearing. It also stimulates your brain and establishes your balance. Well-tuned listening is therefore an essential component for promoting personal development.
This is a common approach to marketing such therapies – argue that one factor is a dominant cause of a host of problems, describe the method for addressing that one factor, which then leads to a happy, healthy, fulfilling life. This marketing formula appears well established. (more…)
Editor’s note: This is an extra “bonus” post. Basically, it’s a revised version of a post I did at my not-so-super-secret-other-blog last week. The issue, however, has disturbed me so much that I felt it appropriate to post it to SBM as well. Fear not. There will be a new post by yours truly on Monday.
Sometimes, in the course of blogging, I come across a story that I don’t know what to make of. Sometimes, it’s a quack or a crank taking a seemingly science-based position. Sometimes it’s something out of the ordinary. Other times, it’s a story that’s just weird, such that I strongly suspect that something else is going on but can’t prove it. So it was a few months ago when I came across the story of Alex Spourdalakis, a 14-year-old autistic boy who became a cause célèbre of the antivaccine crank blog Age of Autism.
I first noticed the story in early March when perusing AoA and came across a post by Lisa Goes entitled Day 19: Chicago Hospital Locks Down Autistic Patient. In the post was a shocking picture of a large 14-year-old boy in a a hospital bed in four-point restraints. He was naked, except for a sheet covering his genitals. A huge gash was torn in the bedsheet, revealing the black vinyl of the hospital bed beneath. The boy’s name, we were informed, was Alex Spourdalakis. Further down in the post was another, equally shocking, picture of Alex that, according to Goes, showed severe dermatitis on Alex’s back due to the hospital sheets. The photos shocked me for two reasons. First, if the story was as advertised (something always to be doubted about any story posted at AoA), for once I thought that I might be agreeing with Goes and thinking that AoA was actually doing a good thing, as disconcerting as that possibility was to me. Second, however, I was extremely disturbed by the publication of such revealing photos of the boy. Undoubtedly, Alex’s mother must have given permission. What kind of mother posts pictures like that of her son for all the world to see? Then there appeared a Facebook page, Help Support Alex Spourdalakis, which pled for readers to help the Spourdalakis family.
As I said, something just didn’t seem right at the time.
It’s frustrating to read yet another story of the process of developing a potential new medical treatment derailed by the current infrastructure of quackery that we have in this and other countries. This is one of the unmeasurable harms that results when pseudoscience is given regulatory, academic, and professional legitimacy. The press then celebrates the nonsense that results.
The basic story is often the same, with a few variations. First, however, let me describe what should happen when someone comes up with an idea for a new medical treatment.
Background research – The first step, whether the innovator is within or without the medical community, is to familiarize oneself with existing research. Is the idea plausible, has it been investigated before, are there any similar treatments that can act as a guide to predicting how this new treatment will work?
The fifth edition of the Diagnostics and Statistical Manual (DSM-5) was recently released. This is the standard reference of mental disorders and psychiatric illnesses released by the American Psychiatric Association (APA).
As with previous editions there is a great deal of discussion and wringing of hands over the details – which disorders were created or eliminated. For example hoarding is now considered its own disorder, rather than part of obsessive compulsive disorder (it has its own reality TV show, why not its own DSM diagnosis?).
This time around, however, the debate over the DSM goes much deeper than the particulars of specific diagnoses. The real debate is about the very existence of the DSM – its validity and utility. While this discussion is nothing new, it has taken on an unprecedented dimension with the rejection of the DSM by the National Institutes of Mental Health (NIMH). Director Thomas Insel wrote:
The goal of this new manual, as with all previous editions, is to provide a common language for describing psychopathology. While DSM has been described as a “Bible” for the field, it is, at best, a dictionary, creating a set of labels and defining each. The strength of each of the editions of DSM has been “reliability” – each edition has ensured that clinicians use the same terms in the same ways. The weakness is its lack of validity. Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever. Indeed, symptom-based diagnosis, once common in other areas of medicine, has been largely replaced in the past half century as we have understood that symptoms alone rarely indicate the best choice of treatment.